Randomized controlled trial of the effectiveness of three different oral moisturizers in palliative care patients.

Most patients in palliative care have problems with dry mouth caused by medication or as a direct result of their condition. Dry mouth may cause problems that affect the primary disease negatively and contribute to poorer quality of life in palliative patients. This randomized controlled trial compared the efficacy of three different oral moisturizers: 17% watery solution of glycerol; oxygenated glycerol triester (marketed as Aequasyal in Europe and as Aquoral in the USA); and a newly developed product, Salient. Of the three products, glycerol provided the best relief from xerostomia directly after application, but had no effect after 2 h. By contrast, the effects of Aequasyal and Salient were largely maintained over the same period. The findings for oral discomfort and pain and speech problems showed a similar pattern. Despite its poor effect after 2 h, patients preferred glycerol over Salient and Aequasyal, probably because of the unpleasant taste of Aequasyal and the consistency and mode of application of Salient. Within the limitations of this study, none of the three products tested was found to be clinically completely adequate. However, the glycerol solution was preferred by this group of patients, and its short-lived effect can be compensated for by frequent applications.

Effect of glycerol on reconstructed human oral mucosa.

The majority of severely ill patients experience dry mouth. For institutionalized patients, this condition is commonly treated using glycerol as a lubricant. However, because of its possibly desiccating effect, some countries do not advocate the use of glycerol. This study aimed to investigate dose-dependent effects of glycerol on homeostasis and tissue integrity of in vitro-reconstructed normal human buccal mucosa (RNHBM). Primary keratinocytes and fibroblasts were isolated and expanded from biopsies of mucosa from eight healthy volunteers. Ninety-six samples of RNHBM were prepared and exposed for 24 h to 17%, 42.5%, or 85% glycerol, or to distilled H2 O (control). Sections were stained with haematoxylin and eosin (H&E) to evaluate epithelial thickness or used for immunohistochemistry to measure expression of Ki67 (proliferation), cleaved caspase-3 (apoptosis), and E-cadherin (tissue-integrity). Positive cells and cell layers, as detected by immunohistochemistry, were counted. Epithelial thickness, proliferation, and apoptosis were significantly increased by exposure to 42.5% and 85% glycerol. No significant differences in apoptosis or proliferation were found between controls and RNHBM exposed to 17% glycerol. E-cadherin expression was not significantly affected by exposure to any of the concentrations of glycerol tested. This study shows that glycerol affects tissue homeostasis, but not tissue integrity, of RNHBM at glycerol concentrations above 42.5%.

End-of-life palliative oral care in Norwegian health institutions. An exploratory study.

OBJECTIVE: To explore circumstances surrounding procedures and knowledge regarding oral care for terminal patients in Norwegian healthcare institutions. METHODS: A questionnaire was distributed to randomly selected hospitals (n = 19) and nursing homes (n = 57) in central and rural parts of Norway. The questionnaire included three closed-ended and three open-ended questions about oral care for terminal patients. If procedures existed, the respondents were asked to enclose or describe them. RESULTS: The response rate was 84% for hospitals and 79% for nursing homes. Of the responding institutions, 25% had no oral care procedures, nor did 48% recognise their importance. Insufficient knowledge about oral care was reported by 39%. Twenty-one different procedures were identified, and a great number of oral care products used. The most common was glycerol, used by 36% of the institutions. Only 2% used a concentration below 30% - the limit above which the glycerol has a desiccating rather than a moistening effect. The most common patient complaint was dry mouth (49%), followed by plaque, food particles and fungus infections, each experienced by 19%. The most common problem for the personnel was lack of knowledge (43%) and patient cooperation (38%). CONCLUSIONS: Some terminal patients do not receive adequate palliative oral care in Norwegian healthcare institutions. Those that do are exposed to a great number of undocumented procedures and sometimes harmful products. There is a need for evidence-based procedures for oral care for terminally ill patients in health institutions, establishing interprofessional palliative healthcare teams and in particular improved training of the nursing staff.

Long-term effect of an oral healthcare programme on oral hygiene in a nursing home.

This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.

Chewing problems and dissatisfaction with chewing ability: a survey of older Tanzanians.

This study assessed the prevalence and correlates of reported chewing problems and dissatisfaction with chewing ability. Discrepancy between reported chewing problems and satisfaction/dissatisfaction with chewing ability was examined. A household survey was conducted in Tanzania in 2004/2005. A total of 1,031 adults (mean age 62.9 yr) underwent clinical examination and a personal interview. Forty per cent [95% confidence interval (CI): 37-43] reported problems with chewing at least one food item, and 25% (95% CI: 22-28) were dissatisfied with their chewing ability. Adjusted odds ratios (OR) for reporting problems with chewing any food were 1.6, 1.2, and 4.2 if having intact anterior/reduced posterior, reduced anterior/intact posterior, and reduced anterior/posterior occluding units, respectively. Subjects dissatisfied with their chewing ability were less likely to be female (OR = 0.6) and more likely to have reduced anterior/posterior occluding units (OR = 3.4), to report dental pain (OR =2.5), chewing problems (OR = 4.7), and oral impacts on daily performances (OIDP) (OR = 3.2). The OIDP scores discriminated between satisfied and dissatisfied groups, irrespective of confirmed chewing problems. Chewing problems and dissatisfaction with chewing ability was prevalent among older Tanzanians. Clinical measures of dentition status, together with reported functional and psychosocial impact scores, determined the subjects' evaluation of their chewing ability and should be taken into account when estimating treatment needs.

Caregivers' perceptions of electric versus manual toothbrushes for the institutionalised elderly.

OBJECTIVE: To evaluate how caregivers feel about the use of electric vs. manual toothbrushes for the elderly in long-term care. MATERIALS AND METHODS: After electric toothbrushes had been accessible in an institution for 15 months, a self-administered questionnaire was distributed to the nursing staff. The questions posed were whether the electric toothbrushes were being used, how much time was spent on brushing and if electric toothbrushes simplified the provision of oral care for the residents. RESULTS: The response rate was 79%. Of the 119 respondents, 78% replied that they always or frequently used an electric toothbrush. With regard to brushing times, 44% of the respondents reported that they spent less time on oral care procedures with an electric toothbrush than with a manual one. Equal amount of time for both types of toothbrushes was reported by 53%. Only 3% reported spending more time with an electric toothbrush than with a manual one. Oral care procedures were considered simpler with this device by 63% of the respondents, 22% registered no change and 15% found it more difficult. If patients suffering from dementia were considered separately, 45% found the procedures simpler when using electric toothbrushes, 24% registered no difference and 31% found it more difficult. CONCLUSION: The findings indicate that when given the choice, the caregivers prefer to use electric toothbrushes rather than manual ones as they feel this is simpler and often less time-consuming.

Clinical and socio-behavioral correlates of tooth loss: a study of older adults in Tanzania.

BACKGROUND: Focusing 50 year olds and above, this study assessed the frequency, extent and correlates of tooth loss due to various reasons. Frequency and correlates of posterior occluding support was also investigated. METHOD: A cross-sectional household survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. One thousand and thirty-one subjects, mean age 62.9 years participated in a clinical examination and completed interviews. RESULTS: The prevalence of tooth loss due to any reason was 83.5%, due to caries 63.4% and due to other reasons than caries, 32.5%. A total of 74.9% had reduced number of posterior occluding units. Compared to subjects having less than 5 teeth lost due to caries, those with 5 or more lost teeth were more likely to be females, having decayed teeth, confirming dental attendance and to be among the least poor residents. Compared to subjects who had lost less than 5 teeth due to reasons other than caries, those who had lost 5 or more teeth were more likely to be of higher age, having mobile teeth, being males, being very poor and to disconfirm dental attendance when having problems. Predictors of prevalence of tooth loss (1 or more lost tooth) due to various reasons and reduced number of occluding units followed similar patterns of relationships. CONCLUSION: The results are consistent with prevalence and extent of tooth loss due to caries and due to reasons other than caries being differently related to disease- and socio- behavioral risk indicators. Caries was the principle cause of tooth loss and molar teeth were the teeth most commonly lost.

Dental technicians' experiences with all-ceramic extra-coronal restorations.

The aim of this study was to identify the dental technicians' experiences with extra-coronal all-ceramic restorations. A questionnaire was mailed to all laboratories registered in The Norwegian Association of Dental Laboratory Owners (n=186). The response was 149 (80%). All-ceramic restorations were produced by 93 (62%) of the responding laboratories. A few of these (1 7%) produced the majority (67%) of the restorations. The dental technicians reported low rates of remakes (median 2%) for all-ceramic restorations. The low production and the limited number of laboratories that perform this work show that there is room for extended training and more expertise in this field.

Ethics of esthetic dentistry.

Patient demand for esthetics has increased globally, and often for reasons of patient self-esteem. However, important ethical issues encompass treatment for purely esthetic reasons. Also, perceptions of what is esthetic differ among patients and clinicians. Therefore, the aim of this article is to make suggestions regarding some of the issues surrounding the ethical, esthetic treatment of patients, as well as present three cases illustrating the different meanings of esthetic health to different people.